• It’s a way for you to tell people what treatment you want or don’t want during a mental health crisis.
  • Keep in mind: a MHAD only applies to your mental health treatment.
• It’s a way to leave instructions for those who will help you with bills, childcare, pets, etc. if you’re hospitalized during a crisis.
• It also gives you the option of appointing a mental healthcare representative who can make mental health decisions for you if you’re unable to do so.

• You may include as much information on your MHAD as you want!
• These are YOUR wishes regarding YOUR mental health treatment. You should include anything YOU want or do not want in terms of treatment.

• Here are some examples of things you may want to include in your MHAD:
• Medications that have been helpful in the past
• Medications that have NOT been helpful in the past
  • Be sure to explain why you do not consent to certain medications—allergies, side effects, etc.
• Other medical conditions or allergies you have that healthcare providers should be aware of
• Physician(s), mental health therapist(s), or any other healthcare professional(s) you would or would NOT like to provide treatment
• Facilities where you would or would NOT like to go if emergency treatment or hospitalizations is required
• Preferred alternatives to hospitalizations
• Transportation instructions to a provider or facility
• Instructions about short-term inpatient treatment
• Instructions about electroconvulsive treatment (ECT) shock therapy
• Instructions about alternative outpatient treatments you prefer
• Your wishes about seclusion and/or restraint
• Your appointed mental healthcare representative, if you choose to have one
• Person(s) to be notified in the event of a mental health crisis
• Person(s) you would or would NOT permit as visitors in the hospital
• Person(s) to notify during a crisis who can help you with bills, childcare, pets, etc.
• Instructions for temporary custody of your dependents during a mental health crisis
  • Your dependents may include: children, elderly parents, supportive service animals, pets, etc.

You can include anything you feel will be helpful in the event of a mental health crisis on your MHAD, such as:

• Your choices regarding future mental health treatment.
  • Remember: This is YOUR opportunity to be specific about YOUR treatment, so be as detailed as possible!
    • If you are refusing treatment, be sure to provide the reason and explain why. Same goes with the treatment you’re requesting!
• Descriptions of your past experiences during a crisis and:
  • What treatment seemed to work best, or
  • What treatment seemed to make the crisis worse and not support your recovery?
• The circumstances under which you would want your MHAD to be followed.
• Your appointed mental healthcare representative’s contact information.
• Instructions about the care of your children, pets, or other dependents in the event of a hospitalization.
• Instructions regarding the upkeep of your home, property, bills, etc. during an extended mental health crisis.

• Yes. Your mental health service provider should follow your MHAD.
• HOWEVER, the provider may not follow your MHAD if:
  • The treatments requested are not feasible or available.
  • It conflicts with emergency treatment.
  • It conflicts with applicable law.
  • It would endanger your life or be dangerous to others.
• If a provider does not honor your MHAD, they must tell you the reason.

• No. Just because part of your MHAD can’t be followed, doesn’t mean the entire thing will be ignored. Your provider should follow the MHAD as closely as circumstances and the law will allow.

• No. In West Virginia, you have the right to refuse to make a MHAD. However, it is something everyone with ongoing mental health treatment should consider.

Your healthcare provider should:

• Inform patients of their right to develop a MHAD.
• Discuss with you—the patient—any of your medical and mental health issues that will be addressed in the MHAD.
• Discuss your preferences regarding treatment, therapeutic services and programs, inpatient facilities, and your preferences on inclusion in studies.
• Find out if certain treatments have worked well or were detrimental to you in the past.
• Discuss any discomfort the provider may have in acting upon any of your treatment choices.
• Discuss whether you should appoint a mental healthcare representative.
• Assist you in a periodic review of your MHAD.

No. Anyone can create a MHAD as long as they are not currently deemed incapacitated or have a court-appointed guardian.

You should consider creating your MHAD as soon as possible.

• Remember: If your MHAD is completed while you are incapacitated or have a court-appointed guardian, it will not be valid.

It will be used only if you are incapacitated or lose the ability to make your own choices about treatment during a mental health crisis.

No. Anyone can write the MHAD as long as it contains your wishes. Others, such as attorneys or mental healthcare advocates, can offer advice and support in creating your MHAD

• Your MHAD ensures that your voice and choices are represented during a mental health crisis.
• It provides YOU with personal empowerment and control over YOUR treatment.
• It can lead to more informed and open discussions with your treatment providers.
• It can prevent clashes between providers over treatment.
• It can decrease the chances of involuntary treatment.
• It allows you to take part in your own continuing care.
• It could possibly shorten your hospital stay.
• It can put others on notice of things you need taken care of during a crisis, such as pets or bills.

Here is a MHAD form and Step-By-Step instructions.

Yes. West Virginia Code of State Rules § 64-75-5 states that an individual “with psychiatric or mental health needs has a right to a MHAD prepared at a time when he/she has not been deemed to be incompetent.”

Your MHAD must contain:

• A statement of your intention or purpose in having an MHAD
• A description of the situation in which the MHAD will become valid (for example: during an involuntary admission)
• A signature page that must be signed in front of a notary and two witnesses.

• No. You have to fill out only the statement of intent page, description of the situation in which the MHAD will become valid, and the signature page.
• The form document we have posted contains other provisions that are not required but which you may find are helpful in your situation. You can pick and choose any (or none) of these other options. Just be SURE you fill in the three required pieces:
  • Statement of Intent (Page 1 of Legal Aid’s form)
  • Description of when the MHAD will come into effect (also on Page 1 of Legal Aid’s form)
  • Signatures Pages (Pages 8 and 9 of Legal Aid’s form)

• No. In West Virginia, you do NOT have to appoint a mental healthcare representative to create a MHAD. Your choices regarding the consent or refusal of treatment and other preferences are still valid even if you do not appoint a mental healthcare representative. For more information on what a Mental Health Representative can do for you read the question “What Is A Mental Health Care Representative?” below.
  • However, this may be different if you do not live in West Virginia. Each state may have its own law.
• Having a Mental Health Care Representative is one of the optional parts of the Legal Aid form. You can appoint one if you think it will help you. You do not have to appoint one.

• No. You can use any format to create your MHAD as long as it has the three required elements:
  • Your intent in creating the document;
  • Description of when the MHAD will come into effect; and
  • Signatures by you, plus two witnesses, plus the Notary Public.
• For your convenience, Legal Aid of WV has created an easy-to-use MHAD form. If you fill it out correctly, the Legal Aid form will satisfy all requirements of the law. You do not have to use this form. But using the Legal Aid form will give you reassurance that your MHAD will be valid and must be followed by doctors, hospitals, therapists, family members and friends.
  • Download a PDF version of our MHAD template.
  • See our Step-By-Step Guide to Completing your MHAD.

• To be valid, your MHAD must be signed by you in front of a notary AND two witness.
• Each witness to your MHAD must be someone who is:
  • Over the age of 18.
  • Not related to you.
  • Not in a position to inherit from you.
  • Not legally responsible for the costs of your medical or other care.
  • Not your doctor.
  • Not your mental healthcare representative or your alternative representative.

• Anyone you trust, such as your mental healthcare representative, a friend, or relative.
• Any healthcare provider you name in your MHAD.
• Any facility where you have been a patient before.
• Any facility where you want to be treated.
• In a safe place with your other important papers
• It’s also a good idea to put a copy in your home where it can be found easily. (Tip: Roll it up in a large baggie with a rubber band around it and put it in the refrigerator. Many emergency responders will look in the refrigerator for this kind of document.)

• Ask your doctors, therapists, and other treatment providers to put a copy of your MHAD in your permanent medical record.
• Keep a copy in a safe place where it can easily be found.
• Complete the Notification of MHAD (Page 11 in the Legal Aid form) and keep it in your purse or wallet.
  • This form states that you have a MHAD, where it is located, and how to contact your mental healthcare representative.

Your MHAD is valid until or unless you revoke it.

• However, it is a good idea to review and update your MHAD at least once a year.

• You may revoke your MHAD at any time by means of a witnessed written note or simply by telling your provider. This means you can revoke your MHAD even if you have been deemed incapacitated. If you revoke when you are in crisis, then doctors, hospitals, therapists, family and friends would not have to follow the MHAD you are now creating.
• HOWEVER, you can take away your power to revoke your MHAD during a time when you are in crisis and do not have decision making capacity. Now, while you have capacity, you simply state in the MHAD that you do not want to be able to revoke the MAHD if you are in a crisis. The Legal Aid for has a “No Revocation While Incapacitated” paragraph. See bottom of Page 7 of the Legal Aid form. Choosing this paragraph will mean:
  • You CAN revoke your MHAD at any time that you DO have capacity; and
  • You CANNOT revoke your MHAD at any time that you DO NOT have capacity.
• The MHAD form provided by Legal Aid of WV gives you this option of “No Revocation While Incapacitated,” (Page 7 of the Legal Aid form). But this can be added to any MHAD format you wish you use or create!

This is the person you appoint to make mental healthcare choices for you in the event you are incapacitated.

• To follow your instructions in the MHAD
• To represent your wishes regarding your mental health care.
• To discuss and review your treatment information.
• To accept or refuse treatment based on your wishes stated in your MHAD.

No. The person you appoint will have no authority until it is determined that you are incapacitated. Later, once you have regained capacity, your mental healthcare representative’s authority automatically ends

• Yes. You can choose exactly what decisions you would or would NOT like your representative to be in control of when you are incapacitated. The representative is required to follow the instructions you put in your MHAD
• Alternatively, you can also allow your representative to have full general control over your mental health decision-making if you are incapacitated.

• IMPORTANT: The decision to appoint a mental healthcare representative should be your choice, and should not be made under pressure or influence
• Choose a person you trust to advocate for you based on your wishes and directions in the MHAD.
• Choose someone over the age of 18.
• Choose someone who is willing to speak with mental healthcare providers and able to understand enough information about your mental health care to make decisions.
• Choose someone who is easy to contact and reasonably available to be involved in your treatment process.
• Before naming a mental healthcare representative, you need to discuss your plans with the person you would like to appoint.
  • Make sure the person you want is actually willing to be your representative AND that they understand your wishes.

• Someone under the age of 18.
• Your mental healthcare provider or their employee, UNLESS they are related to you.
• An owner, operator, or employee of a residential facility where you receive care, UNLESS they are related to you.
• Someone who witnesses or signs your MHAD on your behalf.

1. do not have the resources for the treatment you are requesting, or
2. feel treatment you are asking for will endanger your life or others.

That being said, do not be unreasonable in describing the treatment you desire. Do not request services or treatment that does not exist.

• It may be important to discuss treatment options with your family, friends, and mental health professionals to ensure they will be followed as closely as possible.

As a Mental Healthcare Representative, it’s your role:

• To act for the person in accordance with their wishes regarding mental health care when they are incapacitated.
• To consent or refuse treatment based on that person’s wishes, NOT yours.
• You are NOT a “figurehead” signing off on whatever the provider recommends. Insist that the treatment provider follow the instructions that are stated in the MHAD.
• Be sure to discuss your role as a mental healthcare representative with the person you are representing.

• Keep a copy of the MHAD in an easily accessible place.
• Read and re-read the MHAD of the person you are representing.
• Discuss the treatment options and scenarios with that person to familiarize yourself with their wishes.
• Make sure you and the person you are representing are on the same page!
  • For example: under what circumstances the MHAD will be used, what is expected of you during a crisis, when your role as a representative will end, etc.
• Get as much information from the person you are representing so you can make informed decisions on their behalf.
• Write down EVERYTHING.
  • Becoming a mental healthcare representative is a significant responsibility. Do not take it lightly.
  • It’s very important that you and the person you are representing go over the MHAD together. Talk about every choice and option in the document, and why the person felt it was important to have in the MHAD. Make sure you fully understand their wishes.
• Ask questions!
  • If there’s anything on the MHAD that is unclear or you do not understand, discuss this with the person you are representing.

• Remember that you have the right to get information and records about the person you are representing from their healthcare provider.
• Get as much information as possible from the provider so you can make fully informed decisions.
• Do NOT be afraid to ask questions, and be sure to ask for full explanations.
  • If there’s anything you do NOT understand, ask the staff to explain it in terms you can understand.
  • If you feel uncomfortable—like you don’t have “the whole picture”— say so!
• Do NOT hesitate to insist that you be fully heard.
• Do NOT be afraid to argue for the wishes of the person you are representing.
  • Do not be pushed into a decision before you feel you have an understanding of the situation. With that being said….
• Stay as calm as possible.
  • Getting upset or yelling only undermines your authority and credibility with healthcare providers. This will alienate you from providers and, ultimately, decrease your effectiveness as a mental healthcare representative.
• Write down EVERYTHING.
  • Get any “promises” in writing!
  • Get copies of anything you sign to accept or to refuse treatment.
  • Keep a log of your conversations with providers— date, time, name, position, phone, address, content, decisions—and go back and record the outcome.
    • This may seem tedious, but if there is ever a question regarding your decisions, promises for arrangement or authorization of services, etc., it is better not to rely on memory.